Dr. Compain at PANS/PANDAS Conference

On Saturday, November 15th, Dr. Compain will join several other experts in the PANS/PANDAS field at the New England PANS/PANDAS Association’s Connecticut Educational Conference.

These events are a valuable informational resource for all aspects of the PANS/PANDAS community, including:

  • Exploration of cognitive, behavioral and sensory symptoms
  • Treatment options and protocols (including alternative therapies)
  • Legislative updates
  • Strategies for navigating the educational system
  • Q&A Panel

Dr. Compain is featured on the Q&A panel and will be available to answer questions regarding integrative treatment approaches to PANS/PANDAS.

Through years of practice both Dr. Bock and Dr. Compain have developed protocols to deal with the many challenges present in PANS/PANDAS.  When the immune system is dysregulated, the real question is what else, besides genetics, may be contributing to the autoimmune response. Comprehensive treatment must address the many factors contributing to the immune system imbalance. It requires an individualized, in-depth approach that is the cornerstone of integrative medicine.

Potential Factors Autoimmunity + Chronic inflammation

 

To purchase a ticket to the event, please visit the event page.

Click here to view the Event Flyer.

For MORE information on our approach to PANS/PANDAS, check out Dr. Bock’s presentation:  A Comprehensive Integrative Medicine Approach to Neuroimmune Disorders (PANDAS/PANS)

PANDAS/PANS and Lyme Disease

Chronic Lyme disease and PANDAS/PANS have a number of things in common, among which is the fact that both conditions are controversial and looked at skeptically by mainstream medicine. Physicians doing biomedical work in the pediatric population see a large number of individuals with neurobehavioral disorder, and these two conditions are frequently considered as possible causes in these patients.

PANDAS/PANS is classically described as the fairly sudden onset of OCD behavior or motor tics following a strep infection. In practice, however additional features are often present, including anxiety/separation anxiety, inattention and loss of cognitive function such as math skills. Furthermore, the ‘triggering’ organism may not only be strep. Other possible agents include mycoplasma and viruses.

Similarly, the classic picture of Lyme disease is fatigue, arthritis, cognitive dysfunction, and headache preceded by a characteristic rash. In practice, things are often different, especially in the pediatric population. Here one often sees neuropsychiatric manifestations such as mood disorders, irritability, poor school work, distractibility, light and sound sensitivity and insomnia.

One can see the potential for overlap in the two conditions. There are, for example, reports of Lyme disease causing Tourette’s. Mood disturbances from Lyme disease could certainly present with anxiety similar to that seen in PANDAS/PANS. Both conditions may present with oppositional/defiant behavior or cognitive impairment.

In both conditions, laboratory testing can be helpful but is often not definitive. A positive strep test or strep titer can indicate strep exposure, but doesn’t prove neurological injury in PANS. A positive Lyme titer might also only indicate exposure and not active disease. Conversely, both conditions may seem to occur without positive lab tests, in that an individual with normal test results may have typical symptoms and respond to treatment.

Treating these conditions can be quite complex and both require a comprehensive approach that addresses not only the infecting agents, but also the need to balance and support the immune system, address metabolic deficiencies and sensitivities and provide psychological and behavioral therapies. Psychotropic medications  may be needed.

It is also quite possible that the two conditions can coexist in the same individual, and in fact, we have seen this in numerous patients. Additionally, it has been hypothesized that Lyme disease might be one of the infections that could trigger PANS. Fortunately, treatment regimens can be designed to address both conditions simultaneously.

Silent Liver Disease May Effect 30% of Americans

 

Non Alcoholic Fatty Liver Disease (NAFLD) may not cause symptoms, but it’s become the most common liver condition in the West, affecting as many as 30% of individuals. It can progress to Non Alcoholic Steatohepatis (NASH), which causes liver inflammation and can lead to cirrhosis or liver cancer in about 10% of those affected.

As its name implies, NALFD is characterized by fatty infiltration of the liver. It is a by-product of our epidemic of obesity and is present in about 60% of obese individuals. It appears that increased consumption of carbohydrates, (especially fructose sources such as corn syrup in processed foods) stimulates production of fat in the liver. In addition, individuals with NALFD usually have insulin resistance which not only makes the liver disease worse, but also can lead to heart disease and diabetes.

The liver inflammation is further exacerbated by imbalanced intestinal flora. Obesity itself can also cause inflammation due to chemicals released by our fat cells.

NALFD generally causes no symptoms and it’s usually discovered by finding abnormal liver enzymes levels on routine laboratory testing. An ultrasound can confirm the presence of excess fat in the liver. Laboratory tests such as lipid profiles can detect insulin resistance.

The most important measure to take to combat NALFD is to lower one’s weight, especially by avoiding simple carbohydrates, sugars and high fructose corn syrup. Aerobic exercise will help with weight loss and muscle training can reduce insulin resistance.

A number of nutritional agents have been studied in the treatment of NALFD. Polyunsaturated Fatty Acids (PUFA’s), can be helpful. Omega 3 fish oils have been shown to reduce fatty infiltration on ultrasound, and they’re also anti-inflammatory and reduce insulin resistance. A recent study used Cinnamon (1500mg) to treat NALFD and found that liver enzymes improved (as well as blood sugar, lipids and inflammation markers).¹

Other agents frequently used to reduce liver inflammation and oxidative stress include milk thistle, Phosphatidylcholine and Lipoic acid. Lipoic acid is also a powerful tool to reduce insulin resistance. Vitamin D deficiency is associated with increased severity of NAFLD.

As mentioned above, imbalances in intestinal flora can affect liver inflammation. In fact, bacterial by-products from the intestine directly flow to the liver and stimulate its immune system. Previous studies have shown an improvement in liver pathology with probiotic treatment and a recent trial showed improved liver function tests and reduced markers of inflammations. ²

NALFD is an epidemic and is now being found in children. A dietary and nutritional program to counteract the problem is the best way to prevent it’s serious complications.

¹ Askari F, Rashidkhani B, Hekmatdoost A. Cinnamon may have therapeutic benefits on lipid profile, liver enzymes, insulin resistance, and high-sensitivity C-reactive protein in nonalcoholic fatty liver disease patients. Nutr Res 2014 Feb: 34(2); 143-8

² Eslamparast T, Poutschi H, Zamani F, Sharafkhan M, Malekzadeh R, Hekmatdoost A. Synbiotic supplementation in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled pilot study. Am J Clin Nutr. 2014 Mar: 99(3): 535-42

Electromagnetic Fields (EMF)

By Michael Compain, MD

There has been a growing concern and controversy regarding the health effects of EMF’s, in particular radio/microwave frequencies from cordless devices and extremely low frequencies (ELF) from electrical wiring.

Although there are no definitive conclusions, there have been many studies showing effects of EMF’s on immune function, neurologic function, and the blood brain barrier. Some researchers have raised the possibility that the dramatic increase in neuroimmune conditions such as Autism and PANDAS may be due in part to the significant increase in the EMF fields world wide over the past few decades.

As part of a comprehensive treatment program, one should consider reducing EMF exposure:

  • Avoid cordless devices as much as possible. These would include cordless phones, wireless laptop use, Wi-Fi, baby monitors, etc. One might use corded phones, wired computers, and disconnect wireless routers when not being used. EMF’s from cell phones are harder to avoid, but wired headsets can allow greater distance from the phone during prolonged use, and shielding pouches are available as well. Of course powering off a cell phone eliminates the EMF’s.
  • To reduce ELF, one should locate electronic devices such as alarm clocks, TV’s, and microwaves as far away as possible and avoid electric blankets. Detachable key boards can enable more distance from computer screens.
  • For those who want to more aggressively reduce EMF’s, there are meters available that measure both kinds of fields and there are commercially available shielding devices and filters.

 

 

 

A Nutritional Approach to Alzheimer’s

By Michael Compain, MD

Advances in medical science and public health have steadily prolonged life expectancy in most of the developed world, but the prospect of an exploding population of elderly people has brought with it a host of new challenges. None of these is more formidable than the looming epidemic of Alzheimer’s. The personal, economic and social costs could be staggering, and governments and healthcare specialists are struggling to fashion a response.

On a personal level, individuals are naturally concerned about their own risk as they age. Although there are no perfect tests yet to predict the risk of developing Alzheimer’s, there is a good deal of research in this area. Certainly, one should look at family history as one component. One can also ask ones physician to perform an APO E4 test or measure homocysteine levels which are associated with increased risk.

The decision to embark on a program to reduce the risk or delay the progression to Alzheimer’s is a personal one based on inexact estimates of risk and inconclusive evidence regarding the effectiveness of prevention strategies.

With this in mind, one can begin to design a program of prevention. It should be mentioned, however, that many of the studies in this field have been epidemiologic, small in size or animal studies. Large, long term prospective studies have not been done.

The first place to start is usually to look at one’s diet, and there have been many studies looking at the correlation of diet and Alzheimer’s. The most dramatic findings have been with the Mediterranean Diet. This diet contains mostly whole grains, vegetables, fruits, fish and nuts, and a small amount of dairy and meat. It is high in olive oil and alpha linoleic acid.

Closeup-of-Human-hands-cooking-38754673

There have also been studies looking at some of the individual components of the diet. Fish consumption, nuts and produce have been associated with decreased incidence of Alzheimer’s. Plant flavonoids and dietary antioxidants have also been reported with lower disease incidence. AGEs (Advanced Glycosylated End Products) have been shown to have a negative impact on cognitive function and Alzheimer’s (as well as other degenerative diseases), and these compounds are derived from sugar in the diet.

In addition to diet, another lifestyle intervention is exercise, and here there is also epidemiologic evidence that Alzheimer’s and cognitive decline are less common in those who exercise regularly. Exercising one’s mind with new experiences, intellectual stimulation, puzzles, etc. may have a beneficial effect as well.

a-Senior-Couple-In-Fitness-Cloth

Two of the major metabolic processes that contribute to neurodegenerative conditions like Alzheimer’s are oxidative stress and inflammation. (In fact, many of the chronic illnesses that afflict us are caused by this pair.) Oxidative stress is the damage done to our tissues by ‘free radicals’ which are to some extent derived from oxygen. Inflammation involves stimulation of the immune system, and in the brain this is mediated by cells called microglia.

Antioxidants are compounds that ‘quench’ free radicals. They are obviously components of the dietary elements mentioned above, but they can also be taken as supplements. It is thought by some that antioxidant therapy is more effective if a variety of agents are taken together rather than high doses of individual agents. Some of the antioxidants that may have particular benefit in neurodegenerative diseases such as Alzheimer’s are Lipoic Acid, N-acetyl Cysteine, Coenzyme Q10, Vitamin E, Vitamin C and Vitamin D (which has many other properties as well).

Inflammation can be approached in a variety of ways. It is generally believed that a diet high in animal fat might contain levels of arachidonic acid which can promote inflammation. Conversely, Omega 3 oils such as EPA and DHA from fish oil can be anti-inflammatory and have been proposed as possibly neuroprotective. Phosphatidyl serine, which has been used to improve cognitive function, has been shown to reduce microglial activation, hence reducing brain inflammation. Another agent which has been studied extensively is Curcumin, an ayurvedic remedy that is anti-inflammatory and quite safe to use.

A final element of any program to prevent or slow Alzheimer’s involves environmental toxins. The toxin that has received the most attention is aluminum, and it is generally advised to avoid commercial antiperspirants with aluminum hydroxide and to minimize use of aluminum foil. Other agents that are known to be neurotoxic are heavy metals such as lead, cadmium, and mercury (which can be tested in individuals) and pesticides which are used in homes and gardens and are in our food supply. One should consider avoiding these agents and consuming a more organic diet.

A program such as this is by no means a guarantee, but offers the possibility of preventing or delaying the challenges of this all too common disease.

Metabolic Factors in Cognitive Dysfunction

By Michael Compain, MD

Medical research is revealing that there are certain characteristic metabolic changes that are involved in most degenerative, age-related disorders, and the nervous system is certainly no exception to this pattern. The two major destructive processes are:

  • Oxidative Stress
  • Inflammation.

Oxidative Stress refers to damage caused by electrons/free radicals to cell membranes and other cellular components. The nervous system is particularly sensitive to oxidative stress for a number of reasons. First of all, the brain is an organ that requires a lot of energy and this energy is manufactured by the rich supply of mitochondria in brain cells. This process can unfortunately also generate free radicals. In addition, the nervous system is all about communication between cells and this relies on healthy, well-functioning membranes which are particularly susceptible to oxidative stress.

Inflammation is another fundamental process that is being found in association with a vast number of medical conditions ranging from heart disease, to cancer to osteoporosis. Here again, the nervous system is particularly susceptible and signs of inflammation have been found in Alzheimer’s, Autism, and other neurologic conditions.

Inflammation (as previously mentioned here) can come from many sources including a bad diet, chronic infections, environmental toxins, allergies and intestinal problems. Even obesity and insulin resistance can generate inflammation. Anything that stimulates the immune system can produce inflammation, and, in fact there is constant communication between the immune system and the nervous system. (Most of the ‘systems’ in our body are actually interrelated and terms such as ‘psychoneuroimmunology’ or ‘the neuro-endocrine-immune system’ are being used to reflect this growing awareness).

So one can begin to see the complexity of dealing with a process such as cognitive decline that is mediated by oxidative stress and inflammation, which are in turn due to a long list of possible ‘triggers’.

Where Did I Put My Glasses?

Issues and Approaches to Declining Memory

by Michael Compain, MD

It’s a common refrain and a subject of frequent casual references: the ‘senior moment’.

Those are the episodes when we’re unable to recall a fact, a name, and the title of that book (or the plot).

We seem less organized in our thinking and can’t multitask as well as we used to.

We can’t remember where we put something or why we walked into that room.

Our spouses or friends may comment about our being dizzy or spacey.  We joke about it but we also wonder is it ‘normal aging’ or the early sign of something more serious.

Of course we’re all aware that increased life expectancy has brought with it an epidemic of cognitive decline, and that the projections for Alzheimer’s are sobering. But there is a good deal of cognitive dysfunction that is not due to Alzheimer’s, yet should be evaluated and treated if possible. In addition, there may be nonpharmacologic approaches to preventing or stabilizing Alzheimer’s as well.

Diagnosing Alzheimer’s is usually the purview of neurologists and there are brain scans and other tests that are being developed to help with early diagnosis. There are also screening tests of cognitive function and formal neuropsychological testing to fully document mental capacity and dysfunction.

Measuring and diagnosing dysfunction is important, but in those who are shown to have cognitive issues, the real question becomes why? This is the question that preoccupies physicians who practice integrative/nutritional medicine, whether the problem is memory, fatigue, pain or anything else.

There are a host of metabolic issues that can negatively affect cognitive function and these will be discussed in subsequent posts. But there are also some psychosocial factors that can clearly compromise cognitive function and two of those will be mentioned here.

The first is obvious, but often overlooked: Sleep

Sleep quality and duration often declines with age for a variety of reasons:

  • Melatonin levels may be reduced which can cause difficulty falling asleep as well as maintaining sleep.
  • Obstructive sleep apnea clearly increases with age, and cognitive dysfunction is a hallmark of that condition.
  • Hormonal imbalances in menopause as well as adrenal dysfunction can also negatively affect sleep quality.
  • Increased likelihood of prostate and/or bladder dysfunction.

Other factors that may negatively impact quality sleep include:

  • Stress
  • Poor sleep “hygiene” — the practices and habits leading to sleep.
  • Gastroesophageal reflux.

Many of these problems can be treated without drugs.

Sleep can of course be helped by taking melatonin at bedtime, and herbs such as valerian, passion flower and hops can improve sleep.  5-Hydroxytryptophan can help with both sleep and depression.  For menopausal insomnia, herbs such as wild yam, black cohosh, dong quai and others may be helpful, and bioidentical progesterone can often be used.  Saw palmettos pygeum and nettles can reduce nocturnal prostate symptoms and there are a variety of agents such as licorice, aloe vera and enzymes that may improve reflux.

Another common cause of cognitive decline: Depression or Mood Disorders.

This dementia syndrome of depression is often called Pseudodementia. We usually associate depression with feelings of sadness, social isolation or lack of motivation, but in some instances cognitive decline is the most obvious symptom, and only by probing further does one reveal the underlying mood disorder.  There are a variety of nonpharmacologic approaches to depression.  Nutritional agents such as fish oil, SAMe, St. John’s Wort, B12, inositol and 5-Hydroxytryptophan treat depression.  Sex hormone deficiency can also cause depression and can be treated with the appropriate bioidentical hormones.  It should be noted that depression is often accompanied by insomnia.

For supplements that promote Sleep, click here.

For supplements that promote Emotional and Mood Support, click here.